TORONTO - The Supreme Court's historic ruling that Canadians, under some circumstances, should be allowed to opt for a doctor-assisted death has many physicians in Canada warily reviewing the landmark ruling.

Doctors, like Canadians in general, weigh in at different spots on the spectrum of opinion. Some are ruing the decision, some are resigned to it and others are applauding the new direction set by the highest court in the land.

"We have very sincere and deep concerns about the security of a lot of people," said Dr. Marc Beauchamp of the group Living with Dignity, which opposes doctor-assisted death.

Meanwhile, Dr. James Downar, a palliative and critical care physician from Toronto and co-chair of the physicians' advisory committee for Dying with Dignity, said: "(It's) everything that we were looking for, everything that we were hoping for.''

The Canadian Medical Association represents the middle ground.

The group and its members long opposed the notion of doctors helping people die. But while CMA members still trail behind public opinion on the issue, the group's opposition to assisted death has softened over time.

A 2014 survey of 5,000 doctors found that 45 per cent favoured legalizing physician-assisted death. However, only 27 per cent said they would likely or very likely participate if the act was decriminalized.

And at the CMA's annual meeting last August, 91 per cent of delegates supported a resolution that would let doctors follow their conscience if medically aided dying becomes legal.

The organization has seen the writing on the wall, and has done a lot of work studying laws in other jurisdictions where assisted death is permitted.

President Dr. Chris Simpson said the CMA believes it must play a key role in helping to draft the legislation that is needed to make physician-assisted dying available.

Simpson said Canada's doctors want a seat at the table to ensure the resulting legislation is drafted in a way that protects vulnerable people.

And there needs to be safeguards to ensure that doctors who object can opt out, he said, noting it was reassuring that the Supreme Court acknowledged doctors must have the right to be conscientious objectors.

Some doctors want assurances that they won't even be required to refer a patient to a colleague for help with an assisted death. But Jocelyn Downie, a professor of law and medicine at Dalhousie University, argued that is not an ethical position for doctors to hold.

"I would say that they have a duty to refer. But that will get spelled out in the legislation," Downie said from Halifax.

Many important details remain to be worked out, agreed Dr. Michael Schull, an emergency physician at Toronto's Sunnybrook Health Sciences Centre.

"I think the Supreme Court decision is the right one. (But) I think it's a complicated issue and I think there will be lots of work yet to come on how this gets implemented in a way that people can be comfortable with," Schull said.